Polypoidal Choroidal Vasculopathy Exudation and Hemorrhage: Results of Monthly Ranibizumab Therapy at One Year

Abstract

Purpose: To evaluate the efficacy and safety of monthly intravitreal injections of ranibizumab in patients with polypoidal choroidal vasculopathy (PCV) and active exudation or hemorrhage. Methods: A prospective, single practice, open label trial of monthly intravitreal ranibizumab (0.5 mg) injections for PCV in 13 eyes of 13 patients who completed the 1-year study. The primary outcome measure was stabilization of vision (loss of <15 ETDRS letters). Secondary outcome measures included incidence of ocular and systemic adverse events, changes in subretinal hemorrhage, central foveal thickness, and polypoidal complexes on indocyanine green angiography at 1 year. Results: No patient lost ≥15 letters in visual acuity at 1 year. Three patients (23%) gained ≥15 letters at 12 months. Subretinal hemorrhage resolved in 9/9 eyes (100%). Macular edema improved in 5/5 eyes (100%). Subretinal fluid completely resolved in 4/9 eyes (44%), decreased in 2/9 eyes (22%), and increased in 3/9 eyes (33%). Polypoidal complexes decreased in 5/13 eyes (38%). Conclusion: Continuous monthly intravitreal ranibizumab decreases leakage and hemorrhage in eyes with exudative and hemorrhagic complications of PCV. Branching vascular networks persisted, and polypoidal complexes decreased in only 5/13 (38%) eyes with continuous antiangiogenic therapy at 1 year.

Initial Versus Delayed Photodynamic Therapy in Combination With Ranibizumab for Treatment of Polypoidal Choroidal Vasculopathy

“…Photodynamic therapy-monotherapy causes subretinal hemorrhage, pigment epithelial tear, atrophy of retinal pigment epithelium, and choriocapillaris in the exposure area in addition to a possible VEGF surge, and those may cause the limited visual improvement after PDT. [10][11][12][13][14] Numerous studies have reported the effectiveness of anti-VEGF therapy for treating PCV on the BCVA [29][30][31][32][33] ; however, the main disadvantage of anti-VEGF monotherapy for PCV is less ability to resolve the polypoidal lesions, which leads to early recurrence of fluid. [18][19][20][21] Our previous study found that 33% of eyes with PCV had a dry macula 3 months after the first ranibizumab injection, but ICGA showed persistent polypoidal lesions in 65% of eyes.…”

Polypoidal Choroidal Vasculopathy

“…108e110 Early studies suggested that despite a limited polyp regression rate with anti-VEGF monotherapy (25%e40%), 111e114 anti-VEGF monotherapy has favorable visual outcomes. The PEARL studies 115 consisted of 2 open-label studies of PCV using monthly IVT-R 0.5 mg (PEARL 1 study) or 2.0 mg (PEARL 2 study). In both studies, significant improvement in mean BCVA was accompanied by reduction in subretinal hemorrhage, subretinal fluid, or both.…”

Comparing Ranibizumab and Aflibercept for Treatment of Polypoidal Choroidal Vasculopathy

“…Kokame et al [20] found that monthly intravitreal ranibizumab administration improved vision and facilitated the resolution of subretinal lesions. However, in terms of polyp regression, other studies have demonstrated that ranibizumab monotherapy is less effective than PDT with or without anti-VEGF therapy in achieving this goal [12,13]. In the study by Kokame et al [20], intravitreal ranibizumab showed 33% polyp regression.…”

“…Conventional anti-VEGF monotherapy has also been reported to improve visual and anatomical outcomes. However, the rate of complete polyp regression is low in comparison with that seen after PDT [12,13]. In the six-month results of a randomized, controlled clinical trial for PCV comparing the efficacy of PDT alone, PDT in combination with ranibizumab (Lucentis; Genentech, South San Francisco, CA, USA), and ranibizumab monotherapy (EVEREST study) [11], treatment with PDT alone and that in combination with ranibizumab yielded a higher rate of complete regression of polyps than did ranibizumab monotherapy.…”